Thursday, August 19, 2010

Surgical Prowess, Or Just Really Good Anesthesia

I read this headline in the LA Times the other day, "Surgery in dire conditions can be safe."  The article talks about a study that says there is only a 0.2% mortality rate in 20,000 surgical cases performed in "resource limited areas" from 2001 to 2008.  The study was published in Archives of Surgery

My immediate reaction upon reading this was "Where are the anesthesiologists who should be given at least equal if not greater recognition for allowing surgeons to perform their cases safely in these impoverished conditions? Why isn't there a comparable paper in Anesthesiology called, 'Anesthesia in dire conditions can be safe'? Why do the surgeons get the big write up in a national newspaper while the anesthesiologists who make the cases possible have to stand down away from the spotlight?" I've ranted before about the lack of anesthesia recognition in extremely complicated cases. It doesn't seem just the surgeons get all the glory when anybody with a knife and sutures can slice a body to pieces and put it back together.  It takes a skillful anesthesiologist to make sure the patient survives the ordeal and lives to see another day.  Who was the anesthesiologist when Christiaan Barnard accomplished the first heart transplant?  Who gave the anesthesia when Michael DeBakey performed the first carotid endarterectomy?  Without skilled anesthesiologists, these immortal surgeons would be just hacks with a dead patient on the operating room table.

Look at this study from Archives of Surgery, "Endovascular Repair of Blunt Traumatic Thoracic Aortic Injuries."  Their conclusion says, "Thoracic endovascular aortic repair, via a percutaneous groin approach and without systemic anticoagulation, for blunt thoracic aortic injury can be performed safely with low periprocedural mortality and morbidity." Yeah the surgeons can repair traumatic aortic tears using minimally invasive techniques.  Yippee. The question is who was keeping the patient alive while the surgeons were fiddling with their catheters.  Anybody who has ever treated a trauma patient with thoracic aorta injuries knows it takes a great deal of force to cause this damage.  While the surgeons got a nice paper out of this, the anesthesiologist at the head of the table who was managing all the other injuries in the patients got bupkus. Who was managing the fluid volume?  Who was maintaining blood pressure control?  Who made sure the subject patients did indeed have low mortality and morbidity so the surgeons could dream up their next paper to fill out their C.V.'s?

By contrast, what do anesthesiology journals talk about?  They don't trumpet any advances that generate eyeball grabbing headlines that astonishes the public with the technologic wonders of anesthesia.  We get study after study about the latest research into NMDA receptors or the latest comparative research between bupivacaine and ropivacaine.  Yawn. We anesthesiologists need to get better at promoting the work we do that allows these "miracle" surgeons to shine. We have to make sure people know that behind every great surgeon is a great anesthesiologist.

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